OBJECTIVE: To compare racemic albuterol (RAC) with levalbuterol (LEV) in
continuous form for the treatment of acute pediatric asthma exacerbations in the
emergency department.
STUDY DESIGN: Children between the ages of 6 and 17 inclusive were enrolled if
they had a history of asthma, presented to the emergency department with an acute
asthma exacerbation, and had an initial forced expiratory volume in 1 second
(FEV1) <70% predicted. Patients were then randomized to receive either 7.5 mg of
RAC or 3.75 mg of LEV over 1 hour, in addition to standard asthma therapies.
Spirometry and asthma scoring were performed at the end of the first hour, and a
second hour-long nebulization with the same drug was administered if deemed
necessary. Spirometry and asthma scoring were again performed and the final
disposition was recorded. As a second, optional part of the study, baseline serum
albuterol levels were collected on some patients before treatment.
RESULTS: A total of 99 patients completed the study (44 RAC and 55 LEV). Baseline
characteristics were similar except that the RAC group had a higher baseline
asthma score. Children in the RAC group had a greater improvement in their FEV1
(p = .043) as well as in their asthma scores (p = .01) after 1 hour of continuous
treatment compared to the LEV group. The greater improvement in asthma scores was
maintained after the second hour of continuous therapy in the RAC group (p =
.008) but not for FEV1 measurements (p = .57). There were no differences between
groups for changes in heart rate, respiratory rate, oxygen saturation, or rates
of admission.
CONCLUSIONS: At the doses used, RAC appears to be superior to LEV with respect to
changes in FEV1 and asthma score. There was no significant difference between the
drugs with respect to admission rates or side-effect profile.